Intratympanic gentamicin as a treatment for drop attacks in patients with Meniere's disease

Viana, Lucas Moura; Bahmad, Fayez; Rauch, Steven D.

doi:10.1002/lary.24716

Cited by 37 publications

(28 citation statements)

References 15 publications

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“…VOR gain measured in this way is a global measure of the whole response to a head turn, and as such, it cannot show the fine detail of the time series of the response which may reflect the way in which the sustained and transient systems are combined. Fortuitously, an answer about how these systems work may be provided by the therapeutic treatment of patients with Meniere’s disease by the use of intratympanic injections of gentamicin (ITG) (107–111). …”

Section: Sustained and Transient Aspects Of Behavioral Responsesmentioning

confidence: 99%

Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function

et al. 2017

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Otolithic afferents with regular resting discharge respond to gravity or low-frequency linear accelerations, and we term these the static or sustained otolithic system. However, in the otolithic sense organs, there is anatomical differentiation across the maculae and corresponding physiological differentiation. A specialized band of receptors called the striola consists of mainly type I receptors whose hair bundles are weakly tethered to the overlying otolithic membrane. The afferent neurons, which form calyx synapses on type I striolar receptors, have irregular resting discharge and have low thresholds to high frequency (e.g., 500 Hz) bone-conducted vibration and air-conducted sound. High-frequency sound and vibration likely causes fluid displacement which deflects the weakly tethered hair bundles of the very fast type I receptors. Irregular vestibular afferents show phase locking, similar to cochlear afferents, up to stimulus frequencies of kilohertz. We term these irregular afferents the transient system signaling dynamic otolithic stimulation. A 500-Hz vibration preferentially activates the otolith irregular afferents, since regular afferents are not activated at intensities used in clinical testing, whereas irregular afferents have low thresholds. We show how this sustained and transient distinction applies at the vestibular nuclei. The two systems have differential responses to vibration and sound, to ototoxic antibiotics, to galvanic stimulation, and to natural linear acceleration, and such differential sensitivity allows probing of the two systems. A 500-Hz vibration that selectively activates irregular otolithic afferents results in stimulus-locked eye movements in animals and humans. The preparatory myogenic potentials for these eye movements are measured in the new clinical test of otolith function—ocular vestibular-evoked myogenic potentials. We suggest 500-Hz vibration may identify the contribution of the transient system to vestibular controlled responses, such as vestibulo-ocular, vestibulo-spinal, and vestibulo-sympathetic responses. The prospect of particular treatments targeting one or the other of the transient or sustained systems is now being realized in the clinic by the use of intratympanic gentamicin which preferentially attacks type I receptors. We suggest that it is valuable to view vestibular responses by this sustained-transient distinction.

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Section: Sustained and Transient Aspects Of Behavioral Responsesmentioning

confidence: 99%

Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function

et al. 2017

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“…ITG, as a destructive treatment, could achieve success rates ranging from 60% to 100% in controlling MD-related DA. [10,18] Since both ITG and ITD are well-established treatment for MD, we are led to speculate that ITD may also be used for controlling MD- or DEH-related DA. ITD, free of inner ear toxicity, may attain a compromise between vertigo control and hearing loss.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, our results and previous findings suggested that, ITG, as a more long-lasting and effective alternative, can serve as a subsequent treatment if repeated ITD fails to effectively relieve MD-related DA. [10,19] Although the DA control rate of ITD was not as high as that of ITG, ITD, as a conservative and nondestructive procedure, can not only effectively control DA but also avoid post-ITG hearing loss and disequilibrium associated with use of gentamicin.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, DA associated with MD and DEH represents a life-threatening clinical problem, which needs to be addressed seriously. [10] …”

Section: Introductionmentioning

confidence: 99%

“…Additionally, in some patients, the DA is either very serious or intractable that the aggressive treatment is warranted, [13] including labyrinthectomy, vestibular neurectomy, and intratympanic gentamicin injection (ITG). [10] In the past decades, the intratympanic dexamethasone (ITD), a nondestructive treatment, has become one of primary treatments for MD or DEH. [11] In our clinic, ITD was found to be effective for vertigo control in some MD or DEH patients with DA.…”

Section: Introductionmentioning

confidence: 99%

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Intratympanic steroids injection is effective for the treatment of drop attacks with Ménière's disease and delayed endolymphatic hydrops

et al. 2016

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Drop attack (DA) associated with Ménière's disease (MD) and delayed endolymphatic hydrops (DEH) is not common and may cause life-threatening clinical problems. The intratympanic dexamethasone (ITD) is one of primary treatments for MD or DEH. Our study investigated the effect of ITD on the DA associated with endolymphatic hydrops (EH).We retrospectively reviewed 10 patients with MD- and DEH-associated DA between January 2009 and December 2013 in Outpatient Department of Otolaryngology, Union Hospital, Wuhan, China. Among them, 7 patients (5 cases with MD, 2 cases of DEH) received ITD (4 times, on weekly basis). Further repeated ITD courses or intratympanic gentamicin (ITG) were given if the vertigo was not satisfactorily controlled. The number of DA and status of vertigo control after intratympanic injection were evaluated. After a follow-up study lasting from 19 to 35 months, DA in 5 cases (71.4%) disappeared after initial ITD course. In 2 cases, DA was altogether controlled after an additional intratympanic injection (repeated ITD or/and ITG).This study showed that ITD promises to be a first-line conservative treatment for MD- or DEH-related DA since the steroid possesses no inner-ear toxicity. Furthermore, for MD- or DEH-related DA refractory to ITD, ITG can be an effective alternative.

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Sonderformen des Morbus Menière

Schaaf¹

2017

Morbus Menière

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Intratympanic gentamicin as a treatment for drop attacks in patients with Meniere's disease

Abstract: Intratympanic gentamicin treatment appears to be a long-lasting and effective treatment for MD with DAs.

Cited by 37 publications

References 15 publications

Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function

Sustained and Transient Vestibular Systems: A Physiological Basis for Interpreting Vestibular Function

Intratympanic steroids injection is effective for the treatment of drop attacks with Ménière's disease and delayed endolymphatic hydrops

Sonderformen des Morbus Menière

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